Rehabilitation therapies can lead to recovery from chronic fatigue syndrome

4:00 January 31, 2013

The latest results from the PACE trial show that cognitive behaviour therapy (CBT) and graded exercise therapy (GET), as supplements to specialist medical care, increase the likelihood of recovery from CFS three-fold compared to other treatments studied. The trial is published today in Psychological Medicine.

CFS is a long-term and debilitating condition that affects around 250,000 people in the UK. Symptoms include profound physical and mental fatigue (characteristically made worse by exertion), muscle and joint pain, disturbed sleep and both concentration and memory problems. The researchers studied 640 participants with CFS who were randomised into one of four treatment groups:

Specialist medical care (SMC) alone;

SMC plus adaptive pacing therapy (APT);

SMC plus cognitive behavioural therapy (CBT);

SMC plus graded exercise therapy (GET)

Evidence for recovery was assessed one year after participants were randomly allocated to treatments.

Previous published results showed that both CBT and GET led to greater reductions in symptoms and disability than either APT or SMC. In this analysis the researchers have gone a step further and examined how many patients had recovered from their illness after these treatments. Patients were classed as recovered if they no longer met several criteria for ill health which were initially used to define eligibility for the trial. These included not suffering from significant fatigue or physical disability, and no longer meeting diagnostic criteria for CFS. Patients also had to rate themselves as being “much” or “very much better” in their overall health.

The findings showed that those who received CBT or GET, in addition to SMC, were three times more likely to meet the criteria for recovery than those receiving SMC alone or in combination with APT. Overall 22 per cent of those who received either CBT or GET, in addition to SMC, met the criteria for recovery, compared to eight per cent after APT in addition to SMC, and seven per cent after SMC alone. There were similar patterns of recovery however CFS was defined, including those who were diagnosed as having myalgic encephalomyelitis (ME), thought by some to be the same as CFS and by others as being different.

Professor Trudie Chalder from the Department of Psychological Medicine at King’s College London’s Institute of Psychiatry, said: “The fact that people can recover from chronic fatigue syndrome is excellent news. Healthcare professionals can now be more confident in sharing this possibility with patients, many of whom are understandably concerned about their future.”

Peter White, Professor of Psychological Medicine at Barts and the London School of Medicine and Dentistry, part of Queen Mary, was the lead co-principal investigator of the PACE trial and co-author of the latest paper.

Professor White said: “This is good news and shows that recovery from this debilitating condition is possible for some patients. We now need to go further to understand why only a relatively small proportion of patients recover, which shows how much this condition varies between individuals; one treatment is unlikely to work for everyone.

“Some people may question the use of the term ‘recovery’, and how to define when a patient is ‘recovered’ was a key issue we faced. We focussed on recovery from the current episode of the illness and used several measures of both symptoms and disability to give us the most complete picture possible. Further analysis is needed to see if recovery is sustained in the long-term.”

Professor Michael Sharpe, University of Oxford co-principal investigator of the PACE trial and co-author of the latest paper, said: “The rehabilitative treatments of CBT and GET for CFS have been controversial. This analysis of the PACE trial data shows that not only do they achieve improvements in the majority, but that they can also lead to recovery in a substantial minority.”

The PACE trial was funded by the Medical Research Council, Department of Health, Chief Scientist Office, Scotland, and Department for Work and Pensions.

PACE is the largest ever randomised controlled trial of treatments for CFS/ME, led by researchers at Queen Mary, University of London, the University of Oxford and King’s College London. It began in 2005 and compared four of the main treatments currently available for CFS/ME.

All 640 trial participants received specialist medical care, which included general advice about managing the illness and were prescribed medicines for symptoms such as insomnia and pain.

Patients were randomly divided into four groups and three of the groups were also given one of the following therapies over six months:

Cognitive behavioural therapy (CBT) – An appropriately trained clinical psychologist or nurse helps the patient to understand how their symptoms can be affected by the way that they think about and cope with them, and encourages them to try increasing their activity.

Adaptive pacing therapy (APT) – An appropriately trained occupational therapist helps the patient to match their activity level to the amount of energy they have, aiming to help the patient adapt to the illness rather than assuming they can gradually do more.

CBT and GET are used widely in the health service to treat a range of conditions including rheumatoid arthritis, heart disease, diabetes, depression and chronic pain.

Previous findings from the PACE trial found that CBT and GET in addition to specialist medical care (SMC) were more effective treatments, and better value, than adaptive pacing therapy (APT) with SMC, or SMC alone.

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